Provider Demographics
NPI:1124006549
Name:ELLIS, ROBERT WILLIAM III (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WILLIAM
Last Name:ELLIS
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 W GRAND RIVER AVE
Mailing Address - Street 2:SUITE 260
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-2299
Mailing Address - Country:US
Mailing Address - Phone:517-545-1010
Mailing Address - Fax:517-545-1025
Practice Address - Street 1:204 W GRAND RIVER AVE
Practice Address - Street 2:SUITE 260
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-2299
Practice Address - Country:US
Practice Address - Phone:517-545-1010
Practice Address - Fax:517-545-1025
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-05
Last Update Date:2012-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010976792084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry